Hypotrophy- an eating disorder characterized by varying degrees underweight.

Causes of malnutrition

There are congenital (prenatal) and acquired (postnatal) malnutrition.

Congenital malnutrition is most often caused by maternal diseases or is associated with intrauterine hypoxia, fetal infection, genomic and chromosomal mutations. Among the causes of acquired malnutrition, exogenous and endogenous are distinguished. The first include nutritional factors (hypogalactia in the mother, incorrectly calculated diet during artificial feeding, one-sided feeding, etc.), pyloric stenosis and pylorospasm, drug poisoning(hypervitaminosis D, etc.), infections gastrointestinal tract, deficiencies in care, regime, education, etc. Endogenous reasons malnutrition may include malformations of the gastrointestinal tract and other organs, damage to the central nervous system, hereditary metabolic abnormalities and immunodeficiency conditions, endocrine diseases, etc.

Symptoms of malnutrition

There are malnutrition of I, II and III degrees.

I degree: the thickness of the subcutaneous tissue decreases in all parts of the body except the face. First of all, it thins on the stomach. The mass deficit is 11-20%. Weight gain slows down, growth and neuropsychic development correspond to age. The state of health is usually satisfactory, sometimes there is a disorder of appetite and sleep. The skin is pale, muscle tone and tissue elasticity are slightly below normal, bowel movements and urination are normal.

II degree: subcutaneous tissue on the chest and abdomen almost disappears, on the face it becomes significantly thinner. The child is delayed in growth and neuropsychic development. Weakness and irritability increase, appetite deteriorates significantly, and mobility decreases. The skin is pale with a grayish tint, muscle tone and tissue elasticity are sharply reduced. There are often signs of vitamin deficiency, rickets, and children easily overheat or become hypothermic. The liver enlarges, the stool is unstable (constipation is replaced by diarrhea), its character (color, smell, consistency) changes depending on the cause of malnutrition.

III degree: observed mainly in children in the first 6 months of life and is characterized by severe exhaustion. Subcutaneous tissue disappears in all parts of the body, sometimes remains very thin layer on the cheeks. The mass deficit exceeds 30%. Body weight does not increase, sometimes it decreases progressively. Growth and neuropsychic development are suppressed, lethargy increases, reactions to various stimuli(light, sound, pain). The face is wrinkled, “senile”. Eyeballs and a large fontanel are sinking. The skin is pale gray, dry, skin fold does not straighten out. The mucous membranes are dry, bright red; elasticos

BMI indicators for women

• less than 19- Underweight
• 19 - 24 - Normal body weight
• 24 - 30 - Excess weight body
• 30 - 40 - Obesity
• above 40- Severe obesity

BMI indicators for men

• less than 20- Underweight
• 20 - 25 - Normal body weight
• 25 - 30 - Excess body weight
• 30 - 40 - Obesity
• above 40- Severe obesity

Body mass index or, for short, BMI- this is an approximate value that allows you to indirectly judge whether a person is overweight or obese.

It is useful for every person to know whether he is overweight. Women who are “always losing weight” are especially susceptible to this issue. Often, even slender ladies dream of losing a few kilograms, but they focus only on fashion, and not on the advice of medical specialists.

Even coveted perfect figure may not be so ideal for a particular person. Because the concept of normal depends on height, age, physique (asthenic, hypersthenic or normosthenic), as well as on the rate of progression metabolic processes in the body.

To decide once and for all for yourself main question“Do I need to lose weight or can I wait a little longer?” We recommend knowing your personal indicator - body mass index.

The formula for determining BMI was proposed in the mid-19th century by the sociologist and statistician Adolf Ketele, and mathematical expression body mass index is as follows: a person's body weight in kilograms divided by the square of height in meters.

Despite the fact that there are a large number of methods for assessing body weight and excess fat mass (including Broca’s formula, Lorenz’s formula, formulas for determining fat content, etc.), it is the BMI value that is by far the most indicative and reliable in medically. If you know your body mass index, you can clearly assess your own health risks and susceptibility to obesity-related diseases.

If the BMI value is in the range 16-18.49 , this means that there is a deficiency of body weight and dietary adjustments are necessary to gain weight.

Normal body mass indexes are 18.5-25 for women And 25-27 for men. People with such BMI values, according to statistics, have the longest life expectancy and a much lower risk of developing many serious diseases.

Slight excess normal values BMI with minimal health risk - from 25 to 30. If your values ​​are in this range, it is worth paying extra attention to physical activity and developing habits healthy nutrition. With age (after 30-40 years), weight invariably increases for all people, so try not to gain weight anymore or at least slow down the rate of weight gain.

If the body mass index is more than 30, this is classified as one of the stages. This condition requires immediate measures for weight loss under the supervision of a nutritionist or endocrinologist. To more accurately determine the degree of obesity, you will need additional methods and body fat tests.

It is worth keeping in mind that this formula for determining normal weight not suitable for professional athletes with developed muscles. Calculation using this formula can show them one of the stages of obesity, since it does not take into account the actual fat content in the body.

Another reason why the body mass index may be unreasonably high is edema or concomitant diseases, in which water accumulates in the body.

Obesity(lat. adipositas- literally: “obesity” and lat. obesitas- literally: fullness, obesity, fatness) - fat deposition, increase in body weight due to adipose tissue. Adipose tissue can be deposited both in places of physiological deposits and in the area of ​​the mammary glands, hips, and abdomen.

Obesity is divided into degrees (based on the amount of adipose tissue) and types (depending on the reasons that led to its development). Obesity leads to increased risk the occurrence of diabetes mellitus, hypertension and other diseases associated with the presence overweight. The causes of excess weight also influence the distribution of adipose tissue, the characteristics of adipose tissue (softness, elasticity, percentage of fluid content), as well as the presence or absence of skin changes (stretch marks, enlarged pores, so-called “cellulite”).

What Causes Obesity:

Obesity can develop as a result of:

• imbalance between food intake and energy expended, that is, increased food intake and decreased energy expenditure;
• obesity is not endocrine pathology appears due to disorders in the pancreas, liver, small and large intestines;
• genetic disorders.

Predisposing factors for obesity

• Sedentary lifestyle
• Genetic factors, in particular:
  • Increased activity lipogenesis enzymes
  • Decreased activity of lipolysis enzymes
• Increased consumption of easily digestible carbohydrates:
  • drinking sugary drinks
  • diet rich in sugars
• Certain diseases, in particular endocrine diseases (hypogonadism, hypothyroidism, insulinoma)
• Eating disorders (for example, binge eating disorder), in Russian literature called eating disorders psychological disorder leading to eating disorders
• Tendency to stress
• Lack of sleep
• Psychotropic drugs

In the process of evolution, the human body has adapted to accumulate a reserve nutrients in conditions of abundance of food, in order to spend this supply in conditions of forced absence or limitation of food - a kind of evolutionary advantage that allowed survival. In ancient times, being plump was considered a sign of well-being, prosperity, fertility and health. An example is the sculpture “Venus of Willendorf”, dated to the 22nd millennium BC. e. (possibly the earliest known illustration of obesity).

Viruses

Human infection with adenovirus-36 (Ad-36) ( for a long time was considered a causative agent of respiratory and eye diseases) converts mature adipose tissue stem cells into fat cells; Moreover, those cells in which the virus was not detected remained unchanged.

Pathogenesis (what happens?) during Obesity:

Regulation of the deposition and mobilization of fat from fat depots is carried out by a complex neurohormonal mechanism (cerebral cortex, subcortical formations, sympathetic and parasympathetic nervous system, as well as endocrine glands). The main role in the pathogenesis of obesity is played by dysfunction of the central nervous mechanisms - the cerebral cortex and subthalamus (hypothalamus), where the centers that regulate appetite are located. Impaired coordination between energy expenditure and appetite, which determines the arrival of energy material and intensity metabolic processes, causes fat accumulation. Apparently, the functional state of the centers regulating eating behavior, may have congenital features or acquired (brought up) from childhood in connection with the family’s way of life, the nature of nutrition, etc. Violations functional state hypothalamic centers that regulate appetite may also be a consequence inflammatory process or injuries accompanied by damage to the hypothalamus.

The pathogenesis of obesity cannot be ignored endocrine organs and above all the pituitary gland, adrenal glands, insular apparatus pancreas, thyroid and gonads.

An increase in the functional activity of the pituitary gland - adrenal cortex system and the pancreatic insular apparatus promotes the accumulation of fat in fat depots. A decrease in the somatotropic activity of the adenohypophysis, accompanied by a weakening of the processes of fat mobilization from the depot and its subsequent oxidation in the liver, also acts as a pathogenetic factor, especially in the nutritional-constitutional form of obesity. Plays a certain pathogenetic role in hypothalamic-pituitary obesity thyroid gland(due to a lack of thyroid hormones, the release of fat from fat depots and its oxidation in the liver is inhibited).

Reduced formation of adrenaline - an active lipolytic factor - is essential in reducing the mobilization of fat and is one of the pathogenetic factors of obesity. The role of the gonads in the pathogenesis of primary obesity has not been sufficiently studied.

Symptoms of Obesity:

Clinical manifestations different types obesity are basically similar. There are differences in the distribution of excess fat in the body and in the presence or absence of symptoms of nerve or endocrine system.

Most common nutritional obesity, usually in individuals with a hereditary predisposition to obesity. It develops in cases where the calorie content of food exceeds the body's energy expenditure, and is usually observed in several members of the same family. This type of obesity most often affects middle-aged and elderly women who lead sedentary lifestyle life. When collecting anamnesis with detailed clarification daily ration It is usually established that patients systematically overeat. Nutritional obesity is characterized by a gradual increase in body weight. Subcutaneous adipose tissue distributed evenly, sometimes accumulates to a greater extent in the abdomen and thighs. Signs of defeat endocrine glands however, they are absent.

Hypothalamic obesity observed in diseases of the central nervous system with damage to the hypothalamus (tumors, as a result of injuries, infections). This type of obesity is characterized by rapid development obesity. Fat deposition is observed mainly on the abdomen (in the form of an apron), buttocks, and thighs. Trophic changes in the skin often occur: dryness, white or pink stretch marks (striae). By clinical symptoms(For example, headache, sleep disorders) and the data of a neurological examination of the patient can usually establish brain pathology. How manifestations of hypothalamic disorders are observed along with obesity various signs autonomic dysfunction- increased blood pressure, sweating disorders, etc.

Endocrine obesity develops in patients with certain endocrine diseases (for example, hypothyroidism, Itsenko-Cushing disease), the symptoms of which predominate in clinical picture. On examination, along with obesity, which is usually characterized by uneven deposition of fat on the body, other signs are revealed hormonal disorders(for example, masculinization or feminization, gynecomastia, hirsutism), stretch marks are found on the skin.

A peculiar type of obesity is the so-called painful lipomatosis(Dercum's disease), which is characterized by the presence of fatty nodes that are painful on palpation.

In patients obesity of II-IV degrees changes are noted from cardiovascular system, lungs, digestive organs. Tachycardia, muffled heart sounds, and increased blood pressure are often observed. Sometimes develop respiratory failure and chronic cor pulmonale due to the high position of the diaphragm. Most obese patients have a tendency to constipation, the liver is enlarged due to fatty infiltration of its parenchyma, symptoms are often detected chronic cholecystitis and pancreatitis. There are lower back pain, arthrosis of the knees and ankle joints. Obesity is also accompanied by disorders menstrual cycle, amenorrhea is possible. Obesity is a risk factor for the development of diabetes mellitus, atherosclerosis, hypertension, and coronary heart disease, with which it is often combined.

Obesity in children, as in adults, develops against the background hereditary characteristics or due to acquired metabolic and energy disorders. Obesity is most often observed in the 1st year of life and at 10-15 years. As in adults, exogenous constitutional obesity is more common in children, which is based on a hereditary (constitutional) predisposition to excess fat deposition, often combined with family tendencies to overeat and overfeed children. Excessive fat deposition usually begins as early as the 1st year of life and is not equally common in boys and girls. Girls are born with more developed subcutaneous adipose tissue than boys; This difference increases with age, reaching a maximum in adults, and causes a higher incidence of obesity in girls and women.

Children 10-15 years old have the most common cause obesity is hypothalamic syndrome puberty, which is characterized by the appearance of thin stretch marks on the skin of the thighs, mammary glands, buttocks, and the inner surface of the shoulders. There is, as a rule, a transient increase in blood pressure; in some cases there are signs of increased intracranial pressure. Less commonly, the cause of hypothalamic obesity in children is the consequences of traumatic brain injury or neuroinfection.

Diagnosis of Obesity:

Most commonly used diagnostic criterion obesity is the definition of excess total body weight in relation to the norm established statistically. However, to determine the severity of the disease, it is not so much the excess total body weight that is important, but the excess mass of adipose tissue, which can differ significantly even among individuals of the same age, height and body weight. In this regard, the development and introduction into the clinic of diagnostic techniques for determining body composition and specifically fat mass is quite relevant.

The starting point for determining the degree of obesity is the concept of normal body weight. Normal body weight is determined using special tables taking into account gender, height, body type and age and is the average value corresponding to each group.

Along with the concept of normal body weight, the concept of ideal mass bodies. This indicator was developed at the request of health insurance companies and was supposed to determine at what body weight insured cases (disease or death) are the least likely. It turned out that the body weight at which life expectancy is maximum is approximately 10% less than normal body weight. Ideal body weight is determined taking into account the human constitution (normosthenic, asthenic and hypersthenic). Exceeding this indicator is considered overweight. We speak of obesity in cases where excess body weight is more than 10%.

A number of methods have been proposed to calculate ideal body weight. Most simple formula suggested the anthropologist and surgeon Broca (1868):

Mi = P- 100 ,

Where Mi- ideal body weight, kg, R- height, cm

Depending on the value of this indicator, 4 degrees of obesity are distinguished: 1st degree of obesity corresponds to excess of ideal body weight by 15-29%, 2nd degree - by 30-49%, 3rd - by 50-99%, 4- I am more than 100%.

Currently, the most widely used indicator of obesity is the body mass index (BMI), or Quetelet index:

BMI = Body weight (kg) / height (m2).

It is believed that for people aged 20-55 years old with height close to average (men - 168-188 cm, women - 154-174 cm), BMI fairly accurately reflects the situation. Most studies examining the relationship of body weight with morbidity and mortality confirm that the maximum acceptable body weight corresponds to a BMI of 25 kg/m2.

Classification of excess mbody assemblies in adults depending on BMI (WHO report, 1998)

Measurement of waist and hip circumference. Big clinical significance has not only the severity of obesity, but also the distribution of fat. It must be determined primarily in patients with average overweight, since it does not take into account BMI. It is believed that the risk of complications in obesity largely depends not on excess body weight, but on the localization of adipose tissue deposits. The amount of visceral fat can be measured using MRI. However, a simpler and fairly accurate criterion reflecting the distribution of fat is the ratio of the circumference of the waist and hips (WHR).

Measurement of WTB is important in determining body fat deposition, which is of particular importance in assessing disease risk. Depending on the distribution of fat, there are two types of obesity: android and ganoid. Android, or apple-shaped obesity, refers to the distribution of fat around the waist. The deposition of fat around the buttocks and thighs is known as hypoid, or pear-shaped obesity. In the case of android fat distribution, the likelihood of morbidity and mortality is higher than in the ganoid type. When the bulk of fat is deposited on the body and in abdominal cavity the likelihood of complications associated with obesity increases significantly ( hypertension, ischemic disease hearts, diabetes mellitus type 2). It is believed that normally in women the TTB does not exceed 0.8, and in men - 1; the excess of these parameters is associated with metabolic disorders. If the waist circumference in men reaches 102 cm, and in women - 88 cm, in this case there is a serious risk of increasing the risk of morbidity and weight loss should be recommended (Table 40.3).

Determination of overweight and obesity by waist circumference (cm)

Obesity Treatment:

The main methods of treatment for overweight and obesity

• These include following a diet with increased content fiber, vitamins and other biologically active ingredients(cereals and whole grain products, vegetables, fruits, nuts, herbs, etc.) and limiting the consumption of carbohydrates that are easily digestible by the body (sugar, sweets, baked goods, bakery and pasta made from flour premium grades), as well as physical exercise.
• General approach when drug treatment obesity is to test everyone known drugs for the treatment of obesity. For this purpose, drugs are used to treat obesity.
• If the result drug treatment turns out to be insignificant or absent, then it is necessary to stop such treatment.

Then the question of surgical treatment is considered. Liposuction, an operation during which fat cells are sucked out, is currently not used to combat obesity, but only for the cosmetic correction of local small fat deposits. Although the amount of fat and body weight may decrease after liposuction, according to a recent study by British doctors, such an operation is useless for health. Apparently, it is not the subcutaneous fat that causes harm to health, but the visceral fat located in the omentum, as well as around internal organs located in the abdominal cavity. Previously, isolated attempts were made to perform liposuction for weight loss (the so-called megaliposuction with the removal of up to 10 kg of fat), but at present it is considered extremely harmful and dangerous procedure, which inevitably gives a multitude severe complications and leading to rough cosmetic problems in the form of uneven surface of the body.

Diets often increase obesity. The reason is that a crash diet (a sharp reduction in calorie intake) can help you lose weight quickly, but after stopping the diet, your appetite increases, your food digestibility improves, and you gain weight beyond what you had before the diet. If an obese patient tries to lose weight again using a strict diet, each time losing weight becomes more and more difficult, and gaining weight becomes easier, and the weight gained increases each time. Therefore, diets focused on quick results (lose as much weight as possible in short time), are harmful and dangerous practices. In addition, many weight loss products contain diuretics and laxatives, which leads to water loss rather than fat loss. Losing water is useless for combating obesity, is harmful to health, and weight is restored after stopping the diet.

Moreover, according to a study by American psychologist Tracy Mann and her colleagues, diets are generally useless as a means of combating obesity.

However, it should be noted that without adequate control of the caloric content of food and taking into account the adequacy of the amount of incoming calories physical activity successful treatment obesity is impossible. For successful weight loss, WHO recommends calculating your usual caloric intake, and then reducing the caloric intake by 500 kcal monthly until you reach a figure 300-500 kcal below adequate energy needs. For persons not engaged in active physical labor, this value is 1500-2000 kcal.

Surgical treatment of morbid obesity

As it was found out based on long-term studies, the maximum effect in the treatment of obesity has surgery(bariatric surgery). Only surgical treatment makes it possible to solve this problem completely. Currently, there are mainly two types of surgery used in the world for obesity. In the USA and Canada, gastric bypass surgery is used in the form of Roux-en-Y gastric bypass (90% of all operations). It makes it possible to get rid of 70-80% of excess weight. In Europe and Australia, adjustable gastric banding dominates (90% of all operations), which makes it possible to get rid of 50-60% of excess weight.

Currently, all bariatric surgeries are performed laparoscopically (that is, without an incision, through punctures) under the control of a miniature optical system.

Surgical treatment of obesity has strict indications; it is not intended for those who believe that they simply have overweight. It is believed that indications for surgical treatment obesity occurs with a BMI above 40. However, if the patient has problems such as type 2 diabetes mellitus, hypertension, varicose veins veins and problems with the joints of the legs, indications arise already at a BMI of 35. B lately In the international literature, studies appear that study the effectiveness of gastric banding in patients with a BMI of 30 and above.

Prevention of Obesity:

Obesity prevention is to eliminate physical inactivity and rational nutrition. In children, compliance with feeding rules and regular monitoring is necessary. physical development child by systematically measuring height and body weight (especially with a constitutional predisposition to obesity). Important early detection and treatment of diseases accompanied by hypothalamic and endocrine obesity.

Hypotrophy is a nutrition-dependent condition caused by predominant protein and/or energy starvation of sufficient duration and/or intensity. Protein-energy deficiency is manifested by a complex violation of homeostasis in the form of changes in basic metabolic processes, water-electrolyte imbalance, changes in body composition, disturbances in nervous regulation, endocrine imbalance, depression immune system, dysfunction of the gastrointestinal tract and other organs and their systems.

The impact of malnutrition on actively growing and developing children's body especially unfavorable. Hypotrophy causes a significant delay in the physical and neuropsychic development of the child, resulting in disturbances in immunological reactivity and food tolerance.

Hypotrophy has the following synonyms: protein-energy deficiency, malnutrition type dystrophy, malnutrition syndrome, malnutrition syndrome, hypostatura, malnutrition.

Malnutrition syndrome is a universal concept that reflects the processes occurring in the body when there is a deficiency of any of the essential nutrients (proteins and other energy sources, vitamins, macro- and microelements). Malnutrition can be primary, caused by inadequate nutrient intake, or secondary, caused by impaired intake, assimilation, or metabolism of nutrients due to disease or injury. The narrower concept of “protein-energy deficiency” reflects changes in the body associated with a deficiency primarily of protein and/or other energy substrate.

ICD-10 codes

In ICD-10, protein-energy malnutrition is included in class IV “Diseases of the endocrine system, nutritional disorders and metabolic disorders.”

• E40-E46. Malnutrition.
• E40. Kwashiorkor.
• E41. Nutritional insanity.
• E42. Senile kwashiorkor.
• E43. Severe protein-energy malnutrition, unspecified.
• E44. Protein-energy malnutrition, unspecified, moderate and weak.
• E45. Developmental delay caused by protein-energy deficiency.
• E46. Protein-energy malnutrition, unspecified.

Note. The degree of malnutrition is usually assessed by body weight indicators expressed in standard deviations from average size for the reference population. Lack of weight gain in children or evidence of weight loss in children or adults with one or more previous weight measurements is usually an indicator of malnutrition. If only a single measurement of body weight is available, the diagnosis is based on assumptions and is not considered definitive unless other clinical and laboratory tests. In exceptional cases, when there is no information on body weight, clinical data are taken as a basis.

If an individual's body weight is below the reference population mean, severe malnutrition is highly probable when the observed value is 3 or more standard deviations below the reference population mean; moderate malnutrition if the observed value is 2 or more but less than 3 standard deviations below the mean, and mild degree malnutrition if observed body weight is 1 or more but less than 2 standard deviations below the reference group mean.

Excluded:

• intestinal malabsorption (K90.-)
• nutritional anemia (D50-D53)
• consequences of protein-energy malnutrition (E64.0)
• wasting disease (B22.2)
• fasting (T73.0)

Kwashiorkor

Severe malnutrition accompanied by nutritional edema and pigmentation disorders of the skin and hair

Excluded: senile kwashiorkor (E42)

Nutritional insanity

Senile kwashiorkor

Severe protein-energy malnutrition [as in E43]:

• intermediate form
• with symptoms of kwashiorkor and marasmus

Severe protein-energy malnutrition, unspecified

Severe weight loss in children or adults, or failure to gain weight in a child, that results in an observed weight that is at least 3 standard deviations below the reference group mean (or similar weight loss as measured by other statistical methods) . If only a single weight measurement is available, severe wasting is likely to occur when the measured weight is 3 or more standard deviations below the reference population mean.